Individual provider Active NPI

George B Symonds

  • Optometrist
  • Port Angeles, WA
National Provider Identifier
1124028782
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OD00001757 Issued in WA
Practice address
1122 E Front St
Port Angeles, WA 98362-4308
Phone
(360) 457-1161
Fax
(360) 457-2806
NPI assigned
Jul 26, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OD00001757 WA Primary

Addresses

Primary practice location

1122 E Front St
Port Angeles, WA 98362-4308

Mailing address

1122 E Front St
Port Angeles, WA 98362-4308
Phone (360) 457-1161

Other identifiers 3

IdentifierTypeStateIssuer
2006096MedicaidWA
G000500197OtherWAMEDICARE ID-PIN
0D00001757OtherWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100304000551 WA Practitioner - Optometry 2466597273 Practice locations: Port Angeles, WA

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Pacific University - College of Optometry, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1122 E Front St
Port Angeles, WA 98362-4308
Phone (360) 457-1161

Merit-based Incentive Payment System (MIPS)

Final score
10.3 of 100Reported as individual
Quality
20.61
Improvement activities
0

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery15

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1122336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1124028782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1122 E FRONT ST",
            "city": "PORT ANGELES",
            "state": "WA",
            "postal_code": "983624308",
            "telephone_number": "360-457-1161",
            "fax_number": "360-457-2806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1122 E FRONT ST",
            "city": "PORT ANGELES",
            "state": "WA",
            "postal_code": "983624308",
            "telephone_number": "360-457-1161",
            "fax_number": "360-457-2806"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SYMONDS",
        "first_name": "GEORGE",
        "middle_name": "B",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-07-26",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "OD00001757",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2006096",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID-PIN",
            "identifier": "G000500197",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WA",
            "identifier": "0D00001757",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Angeles, WA

Sources for this page

Verify at the official NPI Registry.